Friday, February 27, 2009

Prostate Cancer, Finasteride, PSA, Prevention part2

Yasterday I talked about the confusion that exists for men in deciding what to do about prostate cancer prevention. The American Urological Association (AUA) and the American Society of Clinical Oncology have recommended the use of finasteride (brand name Proscar) for prevention of prostate cancer in healthy asymptomatic men who get regular blood test screening by evauation of the prostate-specific-antigen (PSA) . At the same time the AUA and other groups continue to remain on the fence about whether or not there should be routine screening, hedging by saying that men should discuss this question with their physician. It's confusing to begin with and now even more so.


Finasteride is a medication that has been around since 1992 and is FDA approved for treatment of urinary symptoms in men with enlarged prostates. Finasteride works by decreasing dihydrotestosterone in the blood and prostate gland which essentially shrinks the prostate. Like all medications it has some side effects and finasteride can cause decreased sexual drive and erectile dysfunction. The findings come from the Prostate Cancer Prevention Trial (PCPT) which began in 1993. This study enrolled 18,882 men and randomized half to placebo and half to the active drug. The study sample was 92% white males, 4% black males, and 4% other ethnic groups. For prostate cancer this is not a true representative sample as black men suffer disproportionally from this disease. The trial was stopped in 2003 because it clearly was effective and ethical concerns made it unreasonable to continue to give some men the placebo.

So the AUA is recommending that men who are screened with the PSA should take medication but they are not recommending routine PSA screening in the first place?!

Why is this? It has to do with the characteristic that many prostate cancers (but not all - mine wasn't) are slow growing and it might take from 6-8 years before a small cancer will penetrate the prostate capsule and infiltrate local structures. Once this happens though there is no cure. Because the PSA screening test has been around awhile it hasn't been used in a widespread fashion until the past 6-8 years so no one has shown conclusively that PSA screening saves lives. In the meantime 30,00 American men are dying each year.

I will discuss more of this next week.

Thought for the day

"Compassion leads to courage".

Lao-tzu

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